Impact of the Treating Hospital on Care Outcomes for Hepatocellular Carcinoma

Ronald T. Cotton; Hop S. Tran Cao; Abbas A. Rana; Yvonne H. Sada; David A. Axelrod; John A. Goss; Mark A. Wilson; Steven A. Curley; Nader N. Massarweh

doi:10.1002/hep.30128

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Impact of the Treating Hospital on Care Outcomes for Hepatocellular Carcinoma

Journal article

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Peer reviewed

Impact of the Treating Hospital on Care Outcomes for Hepatocellular Carcinoma

Ronald T. Cotton, Hop S. Tran Cao, Abbas A. Rana, Yvonne H. Sada, David A. Axelrod, John A. Goss, Mark A. Wilson, Steven A. Curley and Nader N. Massarweh

Hepatology (Baltimore, Md.), Vol.68(5), pp.1879-1889

11/2018

DOI: 10.1002/hep.30128

PMID: 30070392

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Abstract

Multidisciplinary hepatocellular carcinoma (HCC) treatment is associated with optimal outcomes. There are few data analyzing the impact of treating hospitals' therapeutic offerings on survival. We performed a retrospective cohort study of patients aged 18-70 years with HCC in the National Cancer Database (2004-2012). Hospitals were categorized based on the level of treatment offered (Type I—nonsurgical; Type II—ablation; Type III—resection; Type IV—transplant). Associations between overall risk of death and hospital type were evaluated with multivariable Cox shared frailty modeling. Among 50,381 patients, 65% received care in Type IV hospitals, 26% in Type III, 3% in Type II, and 6% in Type I. Overall 5-year survival across modalities was highest at Type IV hospitals (untreated: Type IV—13.1% versus Type I—5.7%, Type II—7.0%, Type III—7.4% [log-rank, P < 0.001]; chemotherapy and/or radiation: Type IV—18.1% versus Type I—3.6%, Type II—4.6%, Type III—7.7% [log-rank, P < 0.001]; ablation: Type IV—33.3% versus Type II—13.6%, Type III—23.6% [log-rank, P < 0.001]; resection: Type IV—48.4% versus Type III—39.1% [log-rank, P < 0.001]). Risk of death demonstrated a dose-response relationship with the hospital type—Type I (ref); Type II (hazard ratio [HR] 0.81, 95% confidence interval [0.73-0.90]); Type III (HR 0.67 [0.62-0.72]); Type IV hospitals (HR 0.43 [0.39-0.47]). Conclusion: Although care at hospitals offering the full complement of HCC treatments is associated with decreased risk of death, one third of patients are not treated at these hospitals. These data can inform the value of health policy initiatives regarding regionalization of HCC care.

Details

Title: Subtitle: Impact of the Treating Hospital on Care Outcomes for Hepatocellular Carcinoma
Creators: Ronald T. Cotton - Baylor College of Medicine
Hop S. Tran Cao - Baylor College of Medicine
Abbas A. Rana - Baylor College of Medicine
Yvonne H. Sada - Baylor College of Medicine
David A. Axelrod - Department of Abdominal Transplantation Lahey Hospital & Medical Clinic Boston MA
John A. Goss - Baylor College of Medicine
Mark A. Wilson - VA Pittsburgh Healthcare System
Steven A. Curley - Michael E. DeBakey VA Medical Center
Nader N. Massarweh - Michael E. DeBakey VA Medical Center
Resource Type: Journal article
Publication Details: Hepatology (Baltimore, Md.), Vol.68(5), pp.1879-1889
DOI: 10.1002/hep.30128
PMID: 30070392
NLM abbreviation: Hepatology
ISSN: 0270-9139
eISSN: 1527-3350
Grant note: award: CIN 13-413; ;
Language: English
Date published: 11/2018
Academic Unit: Surgery
Record Identifier: 9984321862402771

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